There are a set of basic surgical moves, which when sequenced forms a surgical procedure. A fundamental difference between surgical procedures is the orientation of the surgical target upon which basic surgical moves are performed. For example, anastomosis is a key surgical procedure used in establishing continuity in the blood vessels. It consists of a series of steps to suture a vessel or a nerve, starting from grasping the tool, entering the tissue, exiting and tying the knot. However, depending on the orientation of the vessel, the basic movements become more complex. The practice of the surgical tasks such as tool grasping and suture placement is important so is practicing them in different anatomical orientations encountered in surgery. The practice of these surgical moves in natural anatomical positions improves surgery training.
Medical, dental and veterinary students, as well as more experienced doctors dentists and veterinarians learning new surgical techniques, must undergo extensive training before they are optimally qualified to perform surgery. It would be advantageous for students and medical personnel to obtain as much hands-on experience as possible, operating on actual or simulated body structures when learning surgical procedures. These skills are generally learned by observation and didactic instruction from an accomplished surgeon tutor. Learning of these basic skills can be enhanced by viewing video presentations of procedure-specific instructions. Such practice can shorten the learning curve in the operating room.
For example, a student may perform procedures on human cadavers or animals. Both are expensive. In addition, unnecessary surgery on animals is resisted for ethical and legal reasons. Moreover, objective assessment of surgical skill is difficult on animals or cadaver. A surgeon may be trained to a new surgical procedure, but the amount of training time is very insufficient to perfect the practice. Moreover, the training needs to be continuous to sustain the skill. Therefore, even practicing surgeons need a tool to train them outside the operating room. It is observed that an experienced surgeon make less amount of and less number of movements to complete a surgical procedure, resulting less trauma of the surrounding tissue and improved healing time.
Presently, there exist virtual and non-virtual simulators on which to practice surgical skills. Most virtual simulators rely on sophisticated haptic sensors and software integrated with large computer systems that are immobile and often extremely expensive. Teaching institutions that can afford them are usually only able to purchase a limited quantity. Therefore, students often have restricted access and limited times to practice surgical techniques using virtual simulators. In addition, virtual simulators are used for more specialized and complex surgery techniques. For example, endoscopic vessel harvesting systems which are made to model a specific procedure are available. In these specialized prior-art systems, a specific procedure, for example, harvesting of the saphenous vein is modelled. Hence it cannot be adapted to practice newer surgery techniques since it does not teach the basic surgical skills. Basic surgical skills include cutting, knot-tying techniques, suturing techniques, dissection, clamping, clipping, grasping, ligating, cannulation, stapling, cauterization, and suture cutting, among others.
Repetitive practice of these skills is necessary to achieve competency and subsequent mastery characterized by rapidity, automaticity, and delicacy. Coordinated motions of both hands to move and stabilize tissues with the non-dominant hand and precise cutting, clamping, or suturing by the dominant hand are characteristic of most basic surgical tasks. A surgical simulation system ideally should provide facility to practice these basic skills.
Though there are some training tools and kits available, the effectiveness of such training tools are limited due to the disparity between the actual surgery and the surgery training. For example, Lumely's practice block allows synthetic vessels to be placed, divided and sutured for practice. The practice is limited to a 2D orientation and hence is of limited use. In real life surgery, the anatomical orientations are more complex and there is no method for objective analysis of the quality of the suturing.
Many other existing practice systems focus on providing real life simulations such as blood flow, but do not focus on improving surgeons skills to manipulate the tools under anatomical orientations that restrict surgeon's movement. Many of the available systems present the simulated tissue in the horizontal plane, such as natural or synthetic specimens prepared and presented in a convenient horizontal plane. For example, latex sheets provided by ‘Braun’ allow simulation of suturing in various angles but are limited to the horizontal plane.
A similar device called the anastomosis simulator is marketed by Sharpoint, which uses silicone tubes that simulate vessel anastomosis. It is also limited to simulation in one horizontal plane.
Existing systems ignore the fact that coordinated hand movements are difficult when surgical tissues are oriented in oblique or vertical plane which is a more natural presentation of the clinical task. Hence existing surgery training systems do not pose similar type of dexterity challenges as in a real surgery.